腹腔鏡膽囊切除術(Laparoscopic Cholecystectomy,LC)作為一種常規的微創手術,進入臨床實踐不久便迅速成為膽囊切除術的標準手術方式。
《膽囊切除術中預防膽管損傷多協會共識和實踐指南(2020)》對于此類患者(急性膽囊炎、膽囊頸部結石、膽道變異等)建議LC術中行膽道造影以降低膽管損傷的風險。
近年,吲哚菁綠(Indocyanine Green,ICG)熒光膽道造影作為術中識別膽道解剖的新方法,已廣泛應用于多個醫學領域[1-2]。ICG熒光膽道造影技術可無創地顯示肝外膽道并提示膽漏,實時反映術中情況,預防膽道損傷的發生[3]。
膽囊手術中利用熒光導航技術,可以實現對膽總管及膽囊管的定位顯影,有助于肝外膽道系統的可視化,從而避免術中因炎癥、解剖變異等因素造成的顯示不清,進而防止醫源性膽道損傷的發生,以免給患者及其家庭帶來嚴重后果。
術前事先準備好劑量為2mL 2.5mg/mL ICG溶液。全麻成功后,患者取平臥位常規消毒鋪巾,后取頭高腳低左傾位建立氣腹。
Fursight? 超聲軟組織手術設備是遠賽醫療完全自主研發產品:
具備自主知識產權的組織自適應加強技術(Adaptive Reinforce Technology)
智能頻率追蹤技術,提升切凝效率,大大降低熱損傷
自動智能學習功能,加快第一道鎖頻,頻率更精確、切凝更快速
卓越的組織切割能力
強大的血管凝閉能力
更小的熱損傷
高品質材料工藝
人體工學設計
參考文獻:
[1] 張正偉,陳曉寧,孫世波.吲哚菁綠標記熒光腹腔鏡胃癌手術的進展與不足[J].腹腔鏡外科雜志,2021,26(1):77-80.
[2] 王子函,岡天然,武珊珊,等.吲哚菁綠分子熒光影像技術在乳腺癌單孔法腔鏡前哨淋巴結活檢術中的應用[J].腹腔鏡外科雜志,2021,26(5):326-330.
[3] Broderick RC,Lee AM,Cheverie JN,et al.Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy[J].Surg Endosc,2021,35(10):5729-5739.
[4] Dip F,Roy M,Menzo EL,et al.Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy[J].Surg Endosc,2015,29(6):1621-1626.
[5] Liu YY,Liao CH,Diana M,et al.Near-infrared cholecystocholangiography with direct intragallbladder indocyanine green injection:preliminary clinical results[J].Surg Endosc,2018,32(3):1506-1514.
[6] Ishizawa T,Bandai Y,Kokudo N.Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy:an initial experience[J].Arch Surg,2009,144(4):381-382.
[7] 倪忠鵬,張昕輝,劉養歲.吲哚菁綠熒光染色技術在腹腔鏡膽囊切除術中的價值分析[J].腹部外科,2020,33(3):212-217.
[8] Daskalaki D,Fernandes E,Wang X,et al.Indocyanine green(ICG)fluorescent cholangiography during robotic cholecystectomy:results of 184 consecutive cases in a single institution[J].Surg Innov,2014,21(6):615-621.
[9] Papaconstantinou HT,Thomas JS.Single-incision laparoscopic colectomy for cancer:assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy[J].Surgery,2011,150(4):820-827.
[10] Champagne BJ,Papaconstantinou HT,Parmar SS,et al.Single-incision versus standard multiport laparoscopic colectomy:a multicenter,case-controlled comparison[J].Ann Surg,2012,255(1):66-69.
[11] Poon JT,Cheung CW,Fan JK,et al.Single-incision versus conventional laparoscopic colectomy for colonic neoplasm:a randomized,controlled trial[J].Surg Endosc,2012,26(10):2729-2734.
[12] Takemasa I,Uemura M,Nishimura J,et al.Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer:a prospective case-control comparison[J].Surg Endosc,2014,28(4):1110-1118.
[13] 滕文浩,臧衛東,魏丞,等.單孔加一腹腔鏡技術在胃腸手術中的應用現狀與展望[J].腹腔鏡外科雜志,2020,25(1):4-8.
[14] 中國醫師協會微無創專業委員會外科單孔學組.單孔加一腹腔鏡胃癌手術操作專家共識(2020版)[S].腹腔鏡外科雜志,2021,26(1):7-12.
[15]王瀟寧,吳碩東,吳曉東.吲哚菁綠熒光膽道造影在腹腔鏡膽囊切除術中的即時應用體會[J].腹腔鏡外科雜志,2021,26(11):851-857.